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Thiruvengadam K, Krishnan R, Muniyandi M. The Prevalence of Self-Reported Tuberculosis in the Andaman and Nicobar Islands, India: Evidence from the NFHS-IV and V. Trop Med Infect Dis 2023; 8:464. [PMID: 37888592 PMCID: PMC10611087 DOI: 10.3390/tropicalmed8100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/20/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Since 1992, many rounds of the National Family Health Surveys have produced a significant quantity of data in India. The magnitude of the tuberculosis (TB) burden in Andaman and Nicobar Island can be better understood with this data. The household-level information on self-reported TB may provide useful information on the prevalence and distribution of TB as well as care-seeking behaviour. The primary objective is to analyse the data from the NFHS-IV and NFHS-V to understand the prevalence of self-reported TB as well as healthcare-seeking patterns for TB in the Andaman and Nicobar Islands. METHODOLOGY We performed secondary data analysis of NFHS-IV and NFHS-V data. After taking into consideration the survey's cluster design and sampling weights, the prevalence was estimated. The association of identified factors with self-reported TB was investigated using the chi-square and logistic regression models. RESULTS The point prevalence of self-reported TB was 615 (418, 873) and 221 (122, 367) in the NFHS-IV and NFHS-V, respectively (p = 0.012). The elderly, those from rural areas, those belonging to a tribe, and those with a poor wealth index were more likely to report TB. Self-reported TB prevalence was higher in the Nicobar district. There is an increase in a significant proportion of individuals not seeking care. CONCLUSION The NFHS-IV and NFHS-V show a decline in self-reported TB, which is consistent with national estimates. However, the enhanced TB case detection in individuals at high risk of TB among the Nicobar districts and tribal communities could significantly contribute to the fight against tuberculosis. Improved awareness of TB could improve care seeking for TB.
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Affiliation(s)
| | | | - Malaisamy Muniyandi
- ICMR-National Institute for Research in Tuberculosis, Chennai 60031, India; (K.T.)
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Sundaram K, Vajravelu LK, Thulukanam J, Ravi S. A study of analysis on prevalence, serological marker and prognosis of tuberculosis in tertiary care hospital. Indian J Tuberc 2023; 70:398-404. [PMID: 37968044 DOI: 10.1016/j.ijtb.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/18/2023] [Accepted: 04/18/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Tuberculosis is an infectious disease responsible for a significant cause of ill health. According to the WHO global tuberculosis report 2021. 9.9 million cases fell sick with TB in 2020. Significantly, the prevalence of tuberculosis in India is 25%. OBJECTIVE To analyze the prevalence of tuberculosis in the suburban areas of the metropolitan city in South India. To analyze the serological marker and prognosis of tuberculosis among males and females. To determine the importance of molecular testing - PCR confirmation on TB after AFB smear. METHODS A retrospective study to analyze 462 patients enrolled by the respiratory medicine department on suspecting pulmonary- 356 (M-264 & F-92) and extra-pulmonary-106 (M-73&F-33) patients and diagnosed Zhiel-Neelsen staining, Mantoux test, Chip-based RT-PCR test, Erythrocyte sedimentation rate, and analyzed serological test such as C-Reactive Protein, Chemiluminescence immune assay. RESULTS 23 patients were positive in Ziehl-Neelsen staining, 65 were positive in molecular True-Nat PCR test, Mantoux skin test induration in 10 patients, 98 TB Positive patients examined in the serological analysis, 1 & 3 patients reacted in HIV/HBsAg, and HBsAg test respectively, by chemiluminescence immunoassay, 8 PTB and 4 EPTB and 47 non-TB patients were positive in C-reactive protein, 46 TB and 94 non-TB patients detected abnormal values out of these 160 patients in ESR test. CONCLUSION The Prevalence of tuberculosis is significantly rising, especially in the middle-aged population. The rapid molecular diagnostics to detect TB are highly sensitive and specific. Serological markers are essential for the analysis of disease prognosis and need to focus on the guidance of DOTS and RNTCP to End TB.
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Affiliation(s)
- Karthikeyan Sundaram
- Department of Microbiology, SRM Medical College Hospital and Research Centre, Kattangulathur, Chennai 603203, Tamilnadu, India.
| | - Leela Kagithakara Vajravelu
- Department of Microbiology, SRM Medical College Hospital and Research Centre, Kattangulathur, Chennai 603203, Tamilnadu, India
| | - Jayaprakash Thulukanam
- Department of Microbiology, SRM Medical College Hospital and Research Centre, Kattangulathur, Chennai 603203, Tamilnadu, India
| | - Sujith Ravi
- Department of Microbiology, SRM Medical College Hospital and Research Centre, Kattangulathur, Chennai 603203, Tamilnadu, India
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Samuel R, Natesan S, Bangera MK. Quality of life and associating factors in pulmonary tuberculosis patients. Indian J Tuberc 2023; 70:214-221. [PMID: 37100578 DOI: 10.1016/j.ijtb.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 04/25/2022] [Accepted: 05/17/2022] [Indexed: 04/28/2023]
Abstract
BACKGROUND Quality of life is a significant issue among patients with tuberculosis and is used for evaluating treatment responses and therapeutic outcome. This study aimed to assess the quality of life in tuberculosis patients receiving anti-tuberculosis therapy for a short duration in the Vellore district of Tamil Nadu and its associated variables. METHODS A cross-sectional study was designed to evaluate pulmonary tuberculosis patients receiving treatment under category -1 registered in the NIKSHAY portal at Vellore. A total of 165 pulmonary tuberculosis patients were recruited from March 2021 to the third week of June 2021. On obtaining informed consent, the data were collected through the telephone interview by administering WHOQOL- BREF structured questionnaire. The data were examined with descriptive and analytical statistics. Multiple regression analysis for independent quality of life variables was done. RESULTS The lowest median scores, 31(25,38) & 38(25,44) was, related to psychological and environmental domains, respectively. In addition, the Man-Whitney & Kruskal Wallis showed a statistically significant variation in the mean quality of life for gender, employment status, duration of treatment, persistent symptoms, the location of residence of patients, and the stage of therapy. Age, gender, marital status, and persistent symptoms were the main associating factor. CONCLUSION Tuberculosis and its treatment influence psychological, physical functioning, and the environmental domain of patient quality of life. Attention is required in the follow-up and treatment of patients by monitoring their quality of life.
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Affiliation(s)
- Richard Samuel
- National Health Mission, Government of Tamil Nadu, Chennai 600006, Tamil Nadu, India
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Mishra P, Verma VK, Barman L, Sharma J, Gupta P, Mohan A, Arya DS. Correlation of serum amyloid A1 and interleukin-1beta in response to anti-tubercular therapy. Am J Med Sci 2022; 364:316-326. [PMID: 35452629 DOI: 10.1016/j.amjms.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 08/28/2021] [Accepted: 12/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Host biomarkers are needed to monitor the response to anti-tubercular therapy (ATT) for ensuring effective therapy and preventing drug-resistant tuberculosis. We sought to find the correlation between the serum levels of SAA1 and IL-1beta in response to ATT in adult patients with pulmonary TB (PTB) or extra-pulmonary TB (EPTB). METHODS Blood samples of 32 patients with PTB and 28 patients with EPTB were analyzed. The blood samples were collected at baseline, two months and six months following treatment initiation. SAA1 and IL-1beta levels were measured by enzyme linked immunosorbent assay (ELISA). RESULTS In the PTB group, the mean levels of SAA1 decreased significantly (p <0.001) after the intensive phase (two months) and continuous phase (six months) of ATT in comparison with the baseline value. IL-1beta values also decreased significantly (p = 0.005) after the intensive phase (two months) compared with the baseline values. In the EPTB group, there was a significant reduction in the mean serum level of SAA1 (p <0.001) and IL-1beta (p = 0.001) after the intensive phase (two months) in comparison with the baseline value, whereas the reduction at six months was not significant. CONCLUSIONS SAA1 and IL-1beta may be useful potential treatment-monitoring biomarkers, especially in the intensive phase of therapy for both PTB and EPTB.
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Affiliation(s)
- Prashant Mishra
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Vipin Kumar Verma
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Lina Barman
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Jatin Sharma
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pooja Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anant Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Dharamvir Singh Arya
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
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Dolla CK, Dhanaraj B, Chandrasekaran P, Selvaraj S, Menon PA, Thiruvengadam K, Krishnan R, Mondal R, Malaisamy M, Marinaik SB, Murali L, Tripathy SP. Prevalence of bacteriologically confirmed pulmonary tuberculosis and associated risk factors: A community survey in Thirvallur District, south India. PLoS One 2021; 16:e0247245. [PMID: 34610012 PMCID: PMC8491886 DOI: 10.1371/journal.pone.0247245] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 02/03/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) prevalence surveys add to the active case detection in the community level burden of TB both national and regional levels. The aim of this study was to assess the prevalence of bacteriologically confirmed pulmonary tuberculosis (PTB) in the community. METHODS Household community-based tuberculosis disease survey was conducted targeting 69054 population from 43 villages of 5 blocks in Tiruvallure district adopting cluster sampling methodology of ≥15 years old adult rural population of South India during 2015-2018. All eligible individuals with suspected symptoms of PTB were screened with chest X-ray. Two sputum specimens (one spot and the other early morning sample) were collected for M.tb smear and culture examination. Conversely demographical, smoking and alcohol drinking habits information were also collected to explore the risk factor. Stepwise logistic regression was employed to associate risk factors for PTB. RESULTS A total of 62494 were screened among 69054 eligible population, of whom 6340 were eligible for sputum specimen collection. Sputum for M.tb smear and culture examination were collected in 93% of participants. The derived prevalence of PTB was 307/100000 population (smear-positive 130; culture positive 277). As expected that PTB has decreased substantially compared to preceding surveys and it showed that older age, male, low BMI, diabetes, earlier history of TB and alcohol users were significantly associated (p < .0001) with an increased risk of developing PTB. CONCLUSION Upshot of the active survey has established a reduction in the prevalence of PTB in the rural area which can be accredited to better programmatic implementation and success of the National TB Control Programme in this district. It also has highlighted the need for risk reduction interventions accelerate faster elimination of TB.
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Affiliation(s)
- Chandra Kumar Dolla
- Department of Epidemiology, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Bhaskaran Dhanaraj
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | | | - Sriram Selvaraj
- Department of Epidemiology, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Pradeep Aravindan Menon
- Department of Epidemiology, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Kannan Thiruvengadam
- Department of Statistics, Epidemiology Unit, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Rajendran Krishnan
- Department of Statistics, Epidemiology Unit, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Rajesh Mondal
- Department of Bacteriology, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Muniyandi Malaisamy
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Srinivasa B. Marinaik
- Department of Epidemiology, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Lakshmi Murali
- District Tuberculosis Centre, MoHFW, Government of Tamil Nadu, Thiruvallur, Chennai, India
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Thomas BE, Thiruvengadam K, Vedhachalam C, A S, Rao VG, Vijayachari P, Rajiv Y, V R, Bansal AK, Indira Krishna AK, Joseph A, J AP, Hussain T, Anand P, Das P, John KR, Devi K. R, P S, S A, Dusthakeer A, J B, K. Chadha V, G. S. T, Raghunath D, Das M, Khan AM, Kaur H. Prevalence of pulmonary tuberculosis among the tribal populations in India. PLoS One 2021; 16:e0251519. [PMID: 34086684 PMCID: PMC8177518 DOI: 10.1371/journal.pone.0251519] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/27/2021] [Indexed: 01/10/2023] Open
Abstract
Importance There is no concrete evidence on the burden of TB among the tribal populations across India except for few studies mainly conducted in Central India with a pooled estimation of 703/100,000 with a high degree of heterogeneity. Objective To estimate the prevalence of TB among the tribal populations in India. Design, participants, setting A survey using a multistage cluster sampling design was conducted between April 2015 and March 2020 covering 88 villages (clusters) from districts with over 70% tribal majority populations in 17 States across 6 zones of India. The sample populations included individuals ≥15 years old. Main outcome and measures Eligible participants who were screened through an interview for symptoms suggestive of pulmonary TB (PTB); Two sputum specimens were examined by smear and culture. Prevalence was estimated after multiple imputations for non-coverage and a correction factor of 1.31 was then applied to account for non-inclusion of X-ray screening. Results A total of 74532 (81.0%) of the 92038 eligible individuals were screened; 2675 (3.6%) were found to have TB symptoms or h/o ATT. The overall prevalence of PTB was 432 per 100,000 populations. The PTB prevalence per 100,000 populations was highest 625 [95% CI: 496–754] in the central zone and least 153 [95% CI: 24–281] in the west zone. Among the 17 states that were covered in this study, Odisha recorded the highest prevalence of 803 [95% CI: 504–1101] and Jammu and Kashmir the lowest 127 [95% CI: 0–310] per 100,000 populations. Findings from multiple logistic regression analysis reflected that those aged 35 years and above, with BMI <18.5 Kgs /m2, h/o ATT, smoking, and/or consuming alcohol had a higher risk of bacteriologically positive PTB. Weight loss was relatively more important symptom associated with tuberculosis among this tribal populations followed by night sweats, blood in sputum, and fever. Conclusion and relevance The overall prevalence of PTB among tribal groups is higher than the general populations with a wide variation of prevalence of PTB among the tribal groups at zone and state levels. These findings call for strengthening of the TB control efforts in tribal areas to reduce TB prevalence through tribal community/site-specific intervention programs.
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Affiliation(s)
- Beena E. Thomas
- Department of Social and Behavioral Research, ICMR – National Institute for Research in Tuberculosis, Chennai, India
- * E-mail:
| | - Kannan Thiruvengadam
- Department of Statistics, Epidemiology Unit, ICMR – National Institute for Research in Tuberculosis, Chennai, India
| | - Chandrasekaran Vedhachalam
- Department of Statistics, Epidemiology Unit, ICMR – National Institute for Research in Tuberculosis, Chennai, India
| | - Srividya A
- Department of Biostatistics, ICMR – Vector Control Research Centre, Pondicherry, India
| | - V. G. Rao
- Division of Communicable Diseases, ICMR – National Institute for Research in Tribal Health, Jabalpur, India
| | - Paluru Vijayachari
- ICMR – Regional Medical Research Centre, Port Blair, Andaman and Nicobar Islands
| | - Yadav Rajiv
- Division of Communicable Diseases, ICMR – National Institute for Research in Tribal Health, Jabalpur, India
| | - Raghavi V
- Department of Social and Behavioral Research, ICMR – National Institute for Research in Tuberculosis, Chennai, India
| | - Avi Kumar Bansal
- Department of Epidemiology, ICMR – National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | | | - Alex Joseph
- School of Public Health, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Anil Purty J
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Tahziba Hussain
- ICMR – Regional Medical Research Centre, Bhuvaneshwar, India
| | - Praveen Anand
- Department of Epidemiology, ICMR – Desert Medicine Research Centre, Jodhpur, India
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - K. R. John
- Department of Community Medicine, Apollo Institute of Medical Sciences & Research, Chittoor, India
| | - Rekha Devi K.
- ICMR – Regional Medical Research Centre, Dibrugarh, India
| | - Sunish P
- ICMR – Regional Medical Research Centre, Port Blair, Andaman and Nicobar Islands
| | - Azhagendran S
- Department of Social and Behavioral Research, ICMR – National Institute for Research in Tuberculosis, Chennai, India
| | - Azger Dusthakeer
- Department of Bacteriology, ICMR – National Institute for Research in Tuberculosis, Chennai, India
| | - Bhat J
- Division of Communicable Diseases, ICMR – National Institute for Research in Tribal Health, Jabalpur, India
| | - Vineet K. Chadha
- Central Leprosy Teaching and Training Institute, Chengalpet, India
| | - Toteja G. S.
- Department of Epidemiology, ICMR – Desert Medicine Research Centre, Jodhpur, India
| | - Dasarathy Raghunath
- Tribal Task Force, ICMR – Former Dean, Armed Forces Medical College, Pune, India
| | - Madhuchhanda Das
- Division of Communicable Diseases (ECD), Indian Council of Medical Research, New Delhi, India
| | - A. M. Khan
- Division of Communicable Diseases (ECD), Indian Council of Medical Research, New Delhi, India
| | - Hapreet Kaur
- Division of Communicable Diseases (ECD), Indian Council of Medical Research, New Delhi, India
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Hussain T, Tripathy SS, Das S, Satapathy P, Das D, Thomas B, Pati S. Prevalence, risk factors and health seeking behaviour of pulmonary tuberculosis in four tribal dominated districts of Odisha: Comparison with studies in other regions of India. PLoS One 2020; 15:e0227083. [PMID: 32251467 PMCID: PMC7135306 DOI: 10.1371/journal.pone.0227083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/06/2020] [Indexed: 10/25/2022] Open
Abstract
AIM To determine the prevalence of pulmonary tuberculosis, socio-cultural practices and health seeking behaviour of tribal people in four districts of Odisha. METHODOLOGY This was an action research study with qualitative and quantitative design following a sequential approach implemented in a 4-phased manner. It was carried out in the 6 selected villages from July,2015 to June,2017. The screening for active TB among chest symptomatics is followed as per the guidelines of the (RNTCP) Revised National Tuberculosis Control Program in India. RESULTS In all, 1455 households were surveyed in the 6 tribal dominated villages of 4 districts, namely Balangir, Dhenkanal, Kandhamal and Mayurbhanj. Total population of the villages was 6681. Based on the eligibility, 5144 (97.7%) individuals were screened. About 139 (2.3%) could not be screened due to non-availability in their households during day time. Out of the screened individuals (5144), 126 chest symptomatics were identified. Sputum samples were collected from them and sent to the National Reference Laboratory, RMRC, Bhubaneswar using public transport and maintaining cold chain. Out of 126 chest symptomatics, 35 patients were found to be having active TB disease and 18 were culture positive. The prevalence of pulmonary TB is 0.68%. The risk factors seemed to be ignorance about TB symptoms, addiction to alcoholic drinks, difficulty reaching the health facilities owing to the long distances, lack of communication and transport. In addition, other morbidities like Malaria, diabetes, hypertension, malnutrition, etc. were observed in the tribes of the study sites. CONCLUSION TB control programs need further strengthening in the tribal dominated regions. This study is the first of its kind in this State.
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Affiliation(s)
- Tahziba Hussain
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
- * E-mail:
| | | | - Shritam Das
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Dasarathi Das
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Beena Thomas
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
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Ur-Rehman S, Kausar R, Kadri SM, Jan N, Bhat B, Najar S, Chattu VK. Estimation of the burden of bacteriologically positive Tuberculosis among Adults in Kashmir: A baseline for future surveys in the Valley. J Family Med Prim Care 2020; 9:56-60. [PMID: 32110565 PMCID: PMC7014873 DOI: 10.4103/jfmpc.jfmpc_179_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 11/16/2022] Open
Abstract
Background: India has the highest burden of both Tuberculosis and MDR-Tuberculosis based on estimates reported in the Global Tuberculosis Report 2016. The estimates have been revised upwards based on the newer evidence, and the current study was done to estimate the prevalence of bacteriologically positive pulmonary Tuberculosis among the adult population and to provide baseline information for future measurements of Tuberculosis burden and trends. Methods: A cluster-based sampling design was adopted in 10 districts of Kashmir valley in India. Assuming a prevalence of 217 per lakh population, a design effect of 2.5, a relative precision of 0.25% and the expected participation rate of 80%, a sample size of 49,716 was achieved. A total of 67 clusters were identified where each cluster had 750 subjects aged ≥15 years, and eligible individuals were questioned for pulmonary symptoms suggestive of Tuberculosis. Results: Of the total 42,805 that were interviewed, 3.85% had pulmonary Tuberculosis symptoms. A total of 1539 sputum samples were collected from symptomatic and 1351 chest X- rays were done. Cartridge based nucleic acid amplification test (CBNAAT) tests were done on individuals with suspicious X-ray findings. The prevalence of bacteriologically positive pulmonary Tuberculosis was found to be 147 per 100,000 population. Females are affected more than males, and the age of female Tuberculosis patients is less than that of males. Conclusion: The study is the first survey of its kind providing a baseline for further research in the state. CBNAAT is going to be game-changer which surmounts the drawbacks of sputum smear microscopy.
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Affiliation(s)
| | - Rehana Kausar
- Directorate of Health Services, Kashmir, Jammu and Kashmir, India
| | - Syed M Kadri
- Directorate of Health Services, Kashmir, Jammu and Kashmir, India
| | - Nasreen Jan
- Division of Epidemiology and Public Health, Directorate of Health Services, Jammu, Jammu and Kashmir, India
| | - Bilal Bhat
- Department of Statistics, Faculty of Fisheries, Sher-e-Kashmir University of Agricultural Sciences and Technology of Jammu, Jammu, Jammu and Kashmir, India
| | - S Najar
- Directorate of Health Services, Kashmir, Jammu and Kashmir, India
| | - Vijay K Chattu
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada
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9
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Sathiyamoorthy R, Kalaivani M, Aggarwal P, Gupta SK. Prevalence of pulmonary tuberculosis in India: A systematic review and meta-analysis. Lung India 2020; 37:45-52. [PMID: 31898620 PMCID: PMC6961104 DOI: 10.4103/lungindia.lungindia_181_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
The Revised National Tuberculosis Control Program was started in India in 1997. There has been no nationwide survey to assess the prevalence of pulmonary tuberculosis. We aimed to conduct a systematic review and meta-analysis of published literature to provide an estimate of the prevalence of pulmonary tuberculosis in India. Several databases including Medline, Embase, Scopus, the Cochrane Library, Web of Science, and Google Scholar were searched for studies published between January 1, 1997, and December 31, 2018, which reported the prevalence of pulmonary tuberculosis. Community-based cross-sectional studies conducted among population aged 15 years and above were included. Summary estimates were calculated using random effects models. We identified 13 articles with 16 individual studies having screened 961,633 individuals for pulmonary tuberculosis. The pooled prevalence of bacteriologically positive pulmonary tuberculosis was 295.9 (95% confidence interval: 201.1-390.6) per 100,000 population. The prevalence was higher among males than females and in rural areas compared to urban areas. The pooled prevalence of culture-positive pulmonary tuberculosis (277.8/100,000 population) was higher than smear-positive pulmonary tuberculosis (196.6/100,000 population). The pooled prevalence of bacteriologically positive pulmonary tuberculosis in sensitivity analysis was 186.6/100,000 population. In all these estimates, heterogeneity remained high and significant publication bias was observed. The prevalence of pulmonary tuberculosis varied based on sex and distribution of population in rural and urban areas. There is a need of nationwide population-based survey to estimate the burden of tuberculosis to inform control measures and facilitate monitoring and evaluation.
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Affiliation(s)
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Arega B, Tilahun K, Minda A, Agunie A, Mengistu G. Prevalence rate of undiagnosed tuberculosis in the community in Ethiopia from 2001 to 2014: systematic review and meta-analysis. ACTA ACUST UNITED AC 2019; 77:33. [PMID: 31333842 PMCID: PMC6622003 DOI: 10.1186/s13690-019-0360-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/19/2019] [Indexed: 11/10/2022]
Abstract
Background In Ethiopia individual report indicated nearly 30% of incident cases of tuberculosis remained undiagnosed. Therefore, this systematic review and meta-analysis was aimed to determine the pooled prevalence rate of undiagnosed smear positive pulmonary tuberculosis (PTB) using community based studies published in Ethiopia. Methods MEDLINE/PubMed, 'Cochrane' library, and Google scholar databases were searched, and reference list of studies on tuberculosis in Ethiopia were reviewed. We used table to present descriptive information of original studies and quantitative results were presented in forest plots. The Cochrane Q test and I2 test statistic were used to test heterogeneity across studies. The Pooled prevalence and point estimates of undiagnosed smear positive PTB were computed by a random effects model. Results From the nine studies included in the analysis, the pooled prevalence rate and point estimate of undiagnosed smear positive PTB was 0.11%(95% CI, 0.06-013%, p < 0.001) and 79.8/100,000(95% CI; 56.3-112.8) respectively. Pooled prevalence rate and point estimate of bacteriologically confirmed PTB were 0.17%(95%CI; 0.13-0.22%, P < 0.001) and 191/100000(95% CI; 141.3-258) respectively. The ratio of active to passive case detection was 2.3(95% CI, 0.42-4.1). Pooled prevalence rate of presumptive PTB was 2.7%(95% CI; 1.3-5.3%). Conclusions The analysis revealed that the magnitude of undiagnosed smear positive PTB cases in the community is high in Ethiopia. This indicated the ongoing transmission of tuberculosis in community due to missed infectious cases. Active tuberculosis finding in the community should be strengthened in Ethiopia. Trial registration 140611.
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Affiliation(s)
- Balew Arega
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Kelemu Tilahun
- College of Health Science, Wolega University, Wolega, Ethiopia
| | - Abraham Minda
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Asnake Agunie
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Getachew Mengistu
- College of health science, Debere Markos University, Debere Markos, Ethiopia
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11
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Chadha VK, Praseeja P. Active tuberculosis case finding in India - The way forward. Indian J Tuberc 2019; 66:170-177. [PMID: 30878064 DOI: 10.1016/j.ijtb.2018.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/29/2018] [Accepted: 05/16/2018] [Indexed: 11/19/2022]
Abstract
Community based active case finding (ACF) for tuberculosis (TB) has seen resurrection in the current armamentarium of many TB managers in their fight toward eliminating TB. This article explores the accuracy and approximate cost of various ACF algorithms currently in vogue in India or those which could be useful, while inputting the sensitivity and specificity of screening and diagnostic tools as estimated from recently conducted community based surveys. This analysis informs that ACF may be prioritized to higher prevalence settings and the diagnostic algorithm for specific setting may be chosen taking into account the expected prevalence, estimated accuracy of the algorithm and resource availability. Further, chest X-ray cannot be used alone as a diagnostic tool and can be relied upon for this purpose when at least one of the three sputum specimen is smear positive. Accuracy of Xpert MTB/RIF as a diagnostic tool in community situations needs to be investigated further. The review brings out significant proportions of initial default and default during treatment among cases detected through ACF thus emphasizing the need for heightened efforts toward preventing the same. The article rounds off emphasizing priority to addressing barriers to speedy scale up of more sensitive diagnostic tools for health center based case finding including in private sector and ACF in high risk clinical groups for early and efficient case detection. It concludes by putting forth certain research areas that would strengthen future efforts.
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Affiliation(s)
- V K Chadha
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India.
| | - P Praseeja
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India
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12
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Sub-national TB prevalence surveys in India, 2006-2012: Results of uniformly conducted data analysis. PLoS One 2019; 14:e0212264. [PMID: 30794595 PMCID: PMC6386399 DOI: 10.1371/journal.pone.0212264] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/20/2019] [Indexed: 11/19/2022] Open
Abstract
Setting Community based tuberculosis (TB) prevalence surveys in ten sites across India during 2006–2012 Objective To re-analyze data of recent sub-national surveys using uniform statistical methods and obtain a pooled national level estimate of prevalence of TB. Methods Individuals ≥15 years old were screened by interview for symptoms suggestive of Pulmonary TB (PTB) and history of anti-TB treatment; additional screening by chest radiography was undertaken in five sites. Two sputum specimens were examined by smear and culture among Screen-positives. Prevalence in each site was estimated after imputing missing values to correct for bias introduced by incompleteness of data. In five sites, prevalence was corrected for non-screening by radiography. Pooled prevalence of bacteriologically positive PTB was estimated using Random Effects Model after excluding data from one site. Overall prevalence of TB (all ages, all types) was estimated by adjusting for extra-pulmonary TB and Pediatric TB. Results Of 769290 individuals registered, 715989 were screened by interview and 294532 also by radiography. Sputum specimen were examined from 50 852 individuals. Estimated prevalence of smear positive, culture positive and bacteriologically positive PTB varied between 108.4–428.1, 147.9–429.8 and 170.8–528.4 per 100000 populations in different sites. Pooled estimate of prevalence of bacteriologically positive PTB was 350.0 (260.7, 439.0). Overall prevalence of TB was estimated at 300.7 (223.7–377.5) in 2009, the mid-year of surveys. Prevalence was significantly higher in rural compared to urban areas. Conclusion TB burden continues to be high in India suggesting further strengthening of TB control activities.
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Zhang CY, Zhao F, Xia YY, Yu YL, Shen X, Lu W, Wang XM, Xing J, Ye JJ, Li JW, Liu FY, Wu JL, Xu L, Zhang H, Cheng J, Wang LX. Prevalence and risk factors of active pulmonary tuberculosis among elderly people in China: a population based cross-sectional study. Infect Dis Poverty 2019; 8:7. [PMID: 30654836 PMCID: PMC6337869 DOI: 10.1186/s40249-019-0515-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 01/01/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The problem of population aging is a critical public health concern in modern China, and more tuberculosis (TB) control efforts are needed to reach elderly people at high priority. In this study, we aim to determine the prevalence and identify the risk factors of TB among elderly people in China. METHODS A multistage cluster-sampled cross-sectional survey was conducted in 2013, and 27 clusters were selected from 10 counties of 10 provinces in China. All consenting participants greater than or equal to 65 years of age were screened for pulmonary TB with a chest X-ray (CXR) and a symptom questionnaire. Three sputum specimens for bacteriological examination by microscopy and culture were collected from those whose screening was positive. Prevalence was calculated, a multiple logistic regression model was performed to confirm the risk factors, and population attributable fraction (PAF) of each risk factor was calculated to indicate the public health significance. RESULTS Of 38 888 eligible people from 27 clusters, 34 269 participants finished both questionnaire and physical examination. There were 193 active pulmonary TB cases, 62 of which were bacteriologically confirmed. The estimated prevalence of active pulmonary TB and bacteriologically confirmed TB in those 65 years of age and older was 563.19 per 100 000 (95% CI: 483.73-642.65) and 180.92 per 100 000 (95% CI: 135.89-225.96), respectively. Male sex, older age, living in rural areas, underweight, diabetes, close contact of pulmonary TB (PTB) and previous TB history are all risk factors for TB. The risk of TB increased with increasing age and decreasing body mass index (BMI) after adjusting for other factors, and there is a positive dose-response relationship. CONCLUSIONS In China, active case finding (ACF) could be implemented among elderly people aged 65 and above with underweight, diabetes, close contact history and previous TB history as a priority, which will get significant yields and be cost-effective.
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Affiliation(s)
- Can-You Zhang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fei Zhao
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yin-Yin Xia
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan-Ling Yu
- Heilongjiang Provincial Center for Tuberculosis Control and Prevention, Harbin, Heilongjiang, China
| | - Xin Shen
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Wei Lu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Xiao-Meng Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Jin Xing
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Jian-Jun Ye
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, China
| | - Jian-Wei Li
- Center for Tuberculosis Control of Guangdong Province, Guangzhou, Guangdong, China
| | - Fei-Ying Liu
- Guangxi Provincial Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Jian-Lin Wu
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Lin Xu
- Yunnan Provincial Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Hui Zhang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Jun Cheng
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Li-Xia Wang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Moonan PK, Nair SA, Agarwal R, Chadha VK, Dewan PK, Gupta UD, Ho CS, Holtz TH, Kumar AM, Kumar N, Kumar P, Maloney SA, Mase SR, Oeltmann JE, Paramasivan CN, Parmar MM, Rade KK, Ramachandran R, Rao R, Salhorta VS, Sarin R, Sarin S, Sachdeva KS, Selvaraju S, Singla R, Surie D, Tonsing J, Tripathy SP, Khaparde SD. Tuberculosis preventive treatment: the next chapter of tuberculosis elimination in India. BMJ Glob Health 2018; 3:e001135. [PMID: 30364389 PMCID: PMC6195150 DOI: 10.1136/bmjgh-2018-001135] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 01/07/2023] Open
Abstract
The End TB Strategy envisions a world free of tuberculosis—zero deaths, disease and suffering due to tuberculosis by 2035. This requires reducing the global tuberculosis incidence from >1250 cases per million people to <100 cases per million people within the next two decades. Expanding testing and treatment of tuberculosis infection is critical to achieving this goal. In high-burden countries, like India, the implementation of tuberculosis preventive treatment (TPT) remains a low priority. In this analysis article, we explore potential challenges and solutions of implementing TPT in India. The next chapter in tuberculosis elimination in India will require cost-effective and sustainable interventions aimed at tuberculosis infection. This will require constant innovation, locally driven solutions to address the diverse and dynamic tuberculosis epidemiology and persistent programme monitoring and evaluation. As new tools, regimens and approaches emerge, midcourse adjustments to policy and practice must be adopted. The development and implementation of new tools and strategies will call for close collaboration between local, national and international partners—both public and private—national health authorities, non-governmental organisations, research community and the diagnostic and pharmaceutical industry. Leading by example, India can contribute to global knowledge through operational research and programmatic implementation for combating tuberculosis infection.
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Affiliation(s)
- Patrick K Moonan
- Global Tuberculosis Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Reshu Agarwal
- CDC India Country Office, U.S. Centers for Disease Control and Prevention, New Delhi, India
| | - Vineet K Chadha
- Department of Epidemiology and Research, National Tuberculosis Institute, Bangalore, India
| | - Puneet K Dewan
- Global Health, Bill and Melinda Gates Foundation, Seattle, USA
| | - Umesh D Gupta
- National JALMA Institute for Leprosy and other Mycobacterial Diseases, Agra, India
| | - Christine S Ho
- CDC India Country Office, U.S. Centers for Disease Control and Prevention, New Delhi, India
| | - Timothy H Holtz
- CDC India Country Office, U.S. Centers for Disease Control and Prevention, New Delhi, India
| | - Ajay M Kumar
- Department of Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Nishant Kumar
- Revised National Tuberculosis Control Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | | | - Susan A Maloney
- Global Tuberculosis Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sundari R Mase
- WHO India Country Office, World Health Organization, New Delhi, India
| | - John E Oeltmann
- Global Tuberculosis Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - C N Paramasivan
- India Country Office, Foundation for Innovative New Diagnostics, New Delhi, India
| | - Malik M Parmar
- India Country Office, World Health Organization, New Delhi, India
| | - Kiran K Rade
- India Country Office, World Health Organization, New Delhi, India
| | | | - Raghuram Rao
- Revised National Tuberculosis Control Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | - Virendra S Salhorta
- Revised National Tuberculosis Control Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | - Rohit Sarin
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Sanjay Sarin
- India Country Office, Foundation for Innovative New Diagnostics, New Delhi, India
| | - Kuldeep S Sachdeva
- Revised National Tuberculosis Control Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | - Sriram Selvaraju
- Department of Epidemiology, National Institute for Research in Tuberculosis, Chennai, India
| | - Rupak Singla
- Department of Tuberculosis and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Diya Surie
- Global Tuberculosis Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jamhoih Tonsing
- South-east Asia Office, International Union Against Tuberculosis and Lung Disease, New Delhi, India
| | | | - Sunil D Khaparde
- Revised National Tuberculosis Control Programme, India Ministry of Health and Family Welfare, New Delhi, India
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Chadha VK, Anjinappa SM, Rade K, Baskaran D, Narang P, Kolappan C, Ahmed J, Praseeja P. Sensitivity and specificity of screening tools and smear microscopy in active tuberculosis case finding. Indian J Tuberc 2018; 66:99-104. [PMID: 30797292 DOI: 10.1016/j.ijtb.2018.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/30/2018] [Accepted: 05/16/2018] [Indexed: 11/19/2022]
Abstract
SETTING Community based five pulmonary tuberculosis (PTB) surveys among adults. OBJECTIVES Estimate sensitivity and specificity of screening tools for PTB and sputum microscopy. METHODS For each survey site, we estimated sensitivity and specificity of different screening criteria and microscopy against culture; pooled estimates were obtained using Random Effects Model. RESULTS Sensitivity of cough alone, screening for any symptom (persistent cough ≥2 weeks, fever or chest pain ≥1 month, hemoptysis), any symptom or history of anti-TB treatment (h/o ATT) were 56.2%, 66% and 71.2% respectively; specificities were 95.3%, 93.8% and 92.7% respectively. X-ray when used alone for primary screening had sensitivity and specificity of 76.6% and 97.3% respectively. When used along with screening for cough, these figures were 94.3% and 93.1%, and 100% and 97.3% when used with any symptom and h/o ATT. When used for secondary screening, sensitivity and specificity of X-ray was 66.8% and 87.8% respectively after primary screening for cough, 65.0% and 89.8% after screening for any symptom, and 67.1% and 86.7% when used after screening for any symptom or h/o ATT. Pooled sensitivity and specificity of smear was 46.2% and 99.3% respectively. CONCLUSION Program managers may use these estimates while evaluating algorithms for active case finding.
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Affiliation(s)
- V K Chadha
- National Tuberculosis Institute, Bangalore, Karnataka, India.
| | - S M Anjinappa
- National Tuberculosis Institute, Bangalore, Karnataka, India
| | - Kiran Rade
- World Health Organization, India Country Office, New Delhi, India; State TB Cell, Gujarat, Ahmedabad, India; Central TB Division, Government of India, New Delhi, India
| | - D Baskaran
- National Institute for Research in Tuberculosis, Chennai, India
| | - P Narang
- Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India
| | - C Kolappan
- National Institute for Research in Tuberculosis, Chennai, India
| | - J Ahmed
- National Tuberculosis Institute, Bangalore, Karnataka, India
| | - P Praseeja
- National Tuberculosis Institute, Bangalore, Karnataka, India
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Incidence and prevalence of bacteriologically confirmed pulmonary tuberculosis among adolescents and young adults: a systematic review. Epidemiol Infect 2018; 146:946-953. [PMID: 29655391 DOI: 10.1017/s0950268818000821] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The burden of tuberculosis (TB) among adolescents and young adults in endemic settings is poorly characterised. This study aimed to review published and unpublished estimates of the incidence and prevalence of bacteriologically confirmed TB among young people aged 10-24 years. We searched PubMed and World Health Organization archives for publications and unpublished data from population-based epidemiologic studies reporting confirmed pulmonary TB among young people, conducted from January 2000 onwards. We identified 27 publications and unpublished data from two national surveys, representing a total of 26 studies in 19 countries. The prevalence of bacteriologically confirmed TB ranged from 45 to 799 per 100 000 in the Asia-Pacific region and from 160 to 462 per 100 000 in African settings. We did not identify any epidemiologic studies of confirmed TB among adolescents living with human immunodeficiency virus (HIV). Many studies were excluded due to absent or inadequately reported age-specific data. Adolescents and young adults living in many endemic settings appear to be at substantial risk of developing active TB. There is a pressing need to improve the routine reporting of age in epidemiologic studies of TB, and to generate high-quality epidemiologic data regarding TB among adolescents living with HIV.
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Pandey S, Chadha VK, Laxminarayan R, Arinaminpathy N. Estimating tuberculosis incidence from primary survey data: a mathematical modeling approach. Int J Tuberc Lung Dis 2018; 21:366-374. [PMID: 28284250 PMCID: PMC5347365 DOI: 10.5588/ijtld.16.0182] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: There is an urgent need for improved estimations of the burden of tuberculosis (TB). OBJECTIVE: To develop a new quantitative method based on mathematical modelling, and to demonstrate its application to TB in India. DESIGN: We developed a simple model of TB transmission dynamics to estimate the annual incidence of TB disease from the annual risk of tuberculous infection and prevalence of smear-positive TB. We first compared model estimates for annual infections per smear-positive TB case using previous empirical estimates from China, Korea and the Philippines. We then applied the model to estimate TB incidence in India, stratified by urban and rural settings. RESULTS: Study model estimates show agreement with previous empirical estimates. Applied to India, the model suggests an annual incidence of smear-positive TB of 89.8 per 100 000 population (95%CI 56.8–156.3). Results show differences in urban and rural TB: while an urban TB case infects more individuals per year, a rural TB case remains infectious for appreciably longer, suggesting the need for interventions tailored to these different settings. CONCLUSIONS: Simple models of TB transmission, in conjunction with necessary data, can offer approaches to burden estimation that complement those currently being used.
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Affiliation(s)
- S Pandey
- Public Health Foundation of India, New Delhi
| | - V K Chadha
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
| | - R Laxminarayan
- Public Health Foundation of India, New Delhi, Center for Disease Dynamics, Economics & Policy, Washington, DC, Princeton Environmental Institute, Princeton, New Jersey, USA
| | - N Arinaminpathy
- Public Health Foundation of India, New Delhi, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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18
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Kakinda M, Matovu JKB, Obuku EA. A comparision of the yield of three tuberculosis screening modalities among people living with HIV: a retrospective quasi-experiemental study. BMC Public Health 2016; 16:1080. [PMID: 27737681 PMCID: PMC5064918 DOI: 10.1186/s12889-016-3763-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 10/11/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Intensified Case Finding (ICF) tool was approved for TB screening in 2011; however there is still paucity of robust data comparing yields of the different ICF screening modalities. We compared yields of three different screening modalities for TB among Patients Living with HIV (PLHIV) in Uganda in order to inform National TB Programs on the most effective TB screening method. METHODS This was a retrospective quasi-experimental study conducted at an Out-Patient HIV/AIDS clinic in Uganda. We set out to determine yields of three different TB screening modalities at three time periods: 2006/07 where Passive Case Finding (PCF) was used. Here, no screening questions were administered; the clinician depended on the patient's self report. In 2008/09 embedded Intensified Case Finding Tool (e-ICF) was used; here a data capture field was added to the patient clinical encounter forms to compel clinicians to screen for TB symptoms. In 2010/11 Independent Intensified Case Finding Tool (i-ICF) was used; here a screening data collection form, was used, it had the same screening questions as e-ICF. Routine clinical data, including TB status, were collected and entered into an electronic clinical care database. Analysis was done in STATA and the main outcome estimated was the proportional yield of TB cases for each screening modality. RESULTS The overall yield of TB cases was 11.18 % over the entire period of the study (2006 - 2011). The intervention-specific yields were 1.86 % for PCF, 14.95 % for e-ICF and 12.47 % for i-ICF. Use of either e-ICF (OR: 9.2, 95 % CI: 4.81-17.73) or i- ICF (OR: 7.7, 95 % CI: 4.02-14.78) significantly detected more TB cases compared to PCF (P <0.001). While the yields of the Active Case Finding modalities (e-ICF & i-ICF) were not significantly different (OR: 0.98, 95 % CI 0.76-1.27, P = 0.89). CONCLUSION The active screening modalities (e-ICF & i-ICF) had a comparable TB yield and were eight to nine times more efficient in identifying TB cases when compared to the PCF. Cost effectiveness studies would be informative.
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Affiliation(s)
- Michael Kakinda
- Ministry of Health, Plot 6 Lumumba Avenue, P.O. Box 7061, Kampala, Uganda
| | - Joseph K. B. Matovu
- Makerere University College of Health Sciences, School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Ekwaro A. Obuku
- Clinical, Operational and Health Services Research, Joint Clinical Research Centre, P.O. Box 10005, Kampala, Uganda
- Makerere University College of Health Sciences, School of Medicine, P.O. Box 7072, Kampala, Uganda
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK
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The Tuberculosis Cascade of Care in India's Public Sector: A Systematic Review and Meta-analysis. PLoS Med 2016; 13:e1002149. [PMID: 27780217 PMCID: PMC5079571 DOI: 10.1371/journal.pmed.1002149] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/09/2016] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND India has 23% of the global burden of active tuberculosis (TB) patients and 27% of the world's "missing" patients, which includes those who may not have received effective TB care and could potentially spread TB to others. The "cascade of care" is a useful model for visualizing deficiencies in case detection and retention in care, in order to prioritize interventions. METHODS AND FINDINGS The care cascade constructed in this paper focuses on the Revised National TB Control Programme (RNTCP), which treats about half of India's TB patients. We define the TB cascade as including the following patient populations: total prevalent active TB patients in India, TB patients who reach and undergo evaluation at RNTCP diagnostic facilities, patients successfully diagnosed with TB, patients who start treatment, patients retained to treatment completion, and patients who achieve 1-y recurrence-free survival. We estimate each step of the cascade for 2013 using data from two World Health Organization (WHO) reports (2014-2015), one WHO dataset (2015), and three RNTCP reports (2014-2016). In addition, we conduct three targeted systematic reviews of the scientific literature to identify 39 unique articles published from 2000-2015 that provide additional data on five indicators that help estimate different steps of the TB cascade. We construct separate care cascades for the overall population of patients with active TB and for patients with specific forms of TB-including new smear-positive, new smear-negative, retreatment smear-positive, and multidrug-resistant (MDR) TB. The WHO estimated that there were 2,700,000 (95%CI: 1,800,000-3,800,000) prevalent TB patients in India in 2013. Of these patients, we estimate that 1,938,027 (72%) TB patients were evaluated at RNTCP facilities; 1,629,906 (60%) were successfully diagnosed; 1,417,838 (53%) got registered for treatment; 1,221,764 (45%) completed treatment; and 1,049,237 (95%CI: 1,008,775-1,083,243), or 39%, of 2,700,000 TB patients achieved the optimal outcome of 1-y recurrence-free survival. The separate cascades for different forms of TB highlight different patterns of patient attrition. Pretreatment loss to follow-up of diagnosed patients and post-treatment TB recurrence were major points of attrition in the new smear-positive TB cascade. In the new smear-negative and MDR TB cascades, a substantial proportion of patients who were evaluated at RNTCP diagnostic facilities were not successfully diagnosed. Retreatment smear-positive and MDR TB patients had poorer treatment outcomes than the general TB population. Limitations of our analysis include the lack of available data on the cascade of care in the private sector and substantial uncertainty regarding the 1-y period prevalence of TB in India. CONCLUSIONS Increasing case detection is critical to improving outcomes in India's TB cascade of care, especially for smear-negative and MDR TB patients. For new smear-positive patients, pretreatment loss to follow-up and post-treatment TB recurrence are considerable points of attrition that may contribute to ongoing TB transmission. Future multisite studies providing more accurate information on key steps in the public sector TB cascade and extension of this analysis to private sector patients may help to better target interventions and resources for TB control in India.
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Sex Differences in Tuberculosis Burden and Notifications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. PLoS Med 2016; 13:e1002119. [PMID: 27598345 PMCID: PMC5012571 DOI: 10.1371/journal.pmed.1002119] [Citation(s) in RCA: 216] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 07/29/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) case notification rates are usually higher in men than in women, but notification data are insufficient to measure sex differences in disease burden. This review set out to systematically investigate whether sex ratios in case notifications reflect differences in disease prevalence and to identify gaps in access to and/or utilisation of diagnostic services. METHODS AND FINDINGS In accordance with the published protocol (CRD42015022163), TB prevalence surveys in nationally representative and sub-national adult populations (age ≥ 15 y) in low- and middle-income countries published between 1 January 1993 and 15 March 2016 were identified through searches of PubMed, Embase, Global Health, and the Cochrane Database of Systematic Reviews; review of abstracts; and correspondence with the World Health Organization. Random-effects meta-analyses examined male-to-female (M:F) ratios in TB prevalence and prevalence-to-notification (P:N) ratios for smear-positive TB. Meta-regression was done to identify factors associated with higher M:F ratios in prevalence and higher P:N ratios. Eighty-three publications describing 88 surveys with over 3.1 million participants in 28 countries were identified (36 surveys in Africa, three in the Americas, four in the Eastern Mediterranean, 28 in South-East Asia and 17 in the Western Pacific). Fifty-six surveys reported in 53 publications were included in quantitative analyses. Overall random-effects weighted M:F prevalence ratios were 2.21 (95% CI 1.92-2.54; 56 surveys) for bacteriologically positive TB and 2.51 (95% CI 2.07-3.04; 40 surveys) for smear-positive TB. M:F prevalence ratios were highest in South-East Asia and in surveys that did not require self-report of signs/symptoms in initial screening procedures. The summary random-effects weighted M:F ratio for P:N ratios was 1.55 (95% CI 1.25-1.91; 34 surveys). We intended to stratify the analyses by age, HIV status, and rural or urban setting; however, few studies reported such data. CONCLUSIONS TB prevalence is significantly higher among men than women in low- and middle-income countries, with strong evidence that men are disadvantaged in seeking and/or accessing TB care in many settings. Global strategies and national TB programmes should recognise men as an underserved high-risk group and improve men's access to diagnostic and screening services to reduce the overall burden of TB more effectively and ensure gender equity in TB care.
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Management and control of multidrug-resistant tuberculosis (MDR-TB): Addressing policy needs for India. J Public Health Policy 2016; 37:277-299. [PMID: 27153155 DOI: 10.1057/jphp.2016.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Multidrug-resistant tuberculosis (MDR-TB) challenges TB control efforts because of delays in diagnosis plus its long-term treatment which has toxic effects. Of TB high-incidence countries, India carries the highest burden of MDR-TB cases. We describe policy issues in India concerning MDR-TB diagnosis and management in a careful review of the literature including a systematic review of studies on the prevalence of MDR-TB. Of 995 articles published during 2001-2016 and retrieved from the PubMed, only 20 provided data on the population prevalence of MDR-TB. We further reviewed and describe diagnostic criteria and treatment algorithms in use and endorsed by the Revised National TB Control Program of India. We discuss problems encountered in treating MDR-TB patients with standardized regimens. Finally, we provide realistic suggestions for policymakers and program planners to improve the management and control of MDR-TB in India.Journal of Public Health Policy advance online publication, 6 May 2016; doi:10.1057/jphp.2016.14.
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Karadakhy K, Othman N, Ibrahimm F, Saeed AA, Amin AAAH. Tuberculosis in Sulaimaniyah, Iraqi Kurdistan: A Detailed Analysis of Cases Registered in Treatment Centers. TANAFFOS 2016; 15:197-204. [PMID: 28469675 PMCID: PMC5410115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tuberculosis (TB) remains a major public health problem especially in low and middle-income countries. The current study was undertaken to estimate the incidence of the disease and describe its epidemiological characteristics in Iraqi Kurdistan. MATERIALS AND METHODS A retrospective study was carried out on cases registered in the directly observed treatment-short course (DOTS) centers in Sulaimaniyah province. Information was collected from the summary reports of all cases registered in 2010 and detailed information was obtained from 307 cases in the main center. RESULTS During 2010, a total of 530 new and relapsed cases were registered in the DOTS centers amounting to an annual incidence of 31 per 100,000. Over 73% of cases were pulmonary TB and 45% of all cases had positive smear. Most common symptoms were cough (58%), sweating (49%) and fever (48). Almost 43% of patients were diagnosed by direct swab examination, 30% by biopsy and 23% through clinical and radiologic examination. In relation to outcome, 89% of patients were treated successfully, 7% died and 3% defaulted. Mortality rate was 8% in pulmonary infection and 4% in extrapulmonary infection. Old age (65 years and over) was significantly associated with higher odds of death compared to people aged 34 years and younger (OR 6.7, 95% CI 1.3-36.1, P=0.03). CONCLUSION The incidence of TB is still high in the Iraqi Kurdistan. The DOTS has been successful in treating the majority of cases but there are areas needing improvement especially record-keeping and patient follow-up during and after treatment.
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Affiliation(s)
| | - Nasih Othman
- Kurdistan Institution for Strategic Studies & Scientific Research, Sulaimaniyah, Iraq,Correspondence to: Nasih Othman Address: Kurdistan Institution for Strategic Studies & Scientific Research, Sulaimaniyah, Iraq, Email address:
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Rao VG, Bhat J, Yadav R, Muniyandi M, Bhondeley MK, Wares DF. Yield of pulmonary tuberculosis cases by symptoms: Findings from a community survey in Madhya Pradesh, central India. Indian J Tuberc 2015; 62:121-3. [PMID: 26117484 DOI: 10.1016/j.ijtb.2015.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 04/07/2015] [Indexed: 11/19/2022]
Abstract
A cross-sectional tuberculosis prevalence survey was undertaken in Jabalpur district, Madhya Pradesh, central India. All individuals were questioned for chest symptoms. Sputum samples were collected and examined for microscopy and culture. Overall prevalence of sputum positive pulmonary tuberculosis was found to be 255.3 per 100,000 population. Cough, with or without other symptoms, was present in 75.5% individuals and yielded 88.2% of the detected pulmonary tuberculosis cases. Elicitation of a previous history of treatment yielded 5.9%, and chest pain 4.5% cases. History of fever alone yielded no cases. The findings suggest that a history of fever alone may be safely excluded from the list of symptoms to be elicited in future TB prevalence surveys in India.
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Affiliation(s)
- V G Rao
- Regional Medical Research Centre for Tribals (Indian Council of Medical Research), Jabalpur, Madhya Pradesh, India; Scientist F, Regional Medical Research Centre for Tribals (Indian Council of Medical Research), Nagpur Road, P.O. Garha, Jabalpur 482 003, Madhya Pradesh, India.
| | - J Bhat
- Regional Medical Research Centre for Tribals (Indian Council of Medical Research), Jabalpur, Madhya Pradesh, India
| | - R Yadav
- Regional Medical Research Centre for Tribals (Indian Council of Medical Research), Jabalpur, Madhya Pradesh, India
| | - M Muniyandi
- Regional Medical Research Centre for Tribals (Indian Council of Medical Research), Jabalpur, Madhya Pradesh, India
| | - M K Bhondeley
- Regional Medical Research Centre for Tribals (Indian Council of Medical Research), Jabalpur, Madhya Pradesh, India
| | - D F Wares
- Global TB Programme, World Health Organization, Geneva, Switzerland
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Dhanaraj B, Papanna MK, Adinarayanan S, Vedachalam C, Sundaram V, Shanmugam S, Sekar G, Menon PA, Wares F, Swaminathan S. Prevalence and risk factors for adult pulmonary tuberculosis in a metropolitan city of South India. PLoS One 2015; 10:e0124260. [PMID: 25905900 PMCID: PMC4408069 DOI: 10.1371/journal.pone.0124260] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/11/2015] [Indexed: 11/24/2022] Open
Abstract
Background The present study measured the community prevalence and risk factors of adult pulmonary tuberculosis (PTB) in Chennai city, and also studied geographical distribution and the presence of different M. tuberculosis strains in the survey area. Methods A community-based cross sectional survey was carried out from July 2010 to October 2012 in Chennai city. Prevalence of bacteriologically positive PTB was estimated by direct standardization method. Univariate and multivariate analyses were carried out to identify significant risk factors. Drug susceptibility testing and spoligotyping was performed on isolated M. tuberculosis strains. Mapping of PTB cases was done using geographic positioning systems. Results Of 59,957 eligible people, 55,617 were screened by X-ray and /or TB symptoms and the prevalence of smear, culture, and bacteriologically positive PTB was estimated to be 228 (95% CI 189–265), 259 (95% CI 217–299) and 349 (95% CI 330–428) per 100,000 population, respectively. Prevalence of smear, culture, and bacteriologically positive PTB was highest amongst men aged 55–64 years. Multivariate analysis showed that occurrence of both culture and bacteriologically positive PTB disease was significantly associated with: age >35 years, past history of TB treatment, BMI <18.5 Kgs/m2, solid cooking fuel, and being a male currently consuming alcohol. The most frequent spoligotype family was East African Indian. Spatial distribution showed that a high proportion of patients were clustered in the densely populated north eastern part of the city. Conclusion Our findings demonstrate that TB is a major public health problem in this urban area of south India, and support the use of intensified case finding in high risk groups. Undernutrition, slum dwelling, indoor air pollution and alcohol intake are modifiable risk factors for TB disease.
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Affiliation(s)
| | | | | | | | | | | | - Gomathi Sekar
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Fraser Wares
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Soumya Swaminathan
- National Institute for Research in Tuberculosis, Chennai, India
- * E-mail:
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Aggarwal AN, Gupta D, Agarwal R, Sethi S, Thakur JS, Anjinappa SM, Chadha VK, Kumar R, Sharma M, Behera D, Jindal SK. Prevalence of pulmonary tuberculosis among adults in a north Indian district. PLoS One 2015; 10:e0117363. [PMID: 25695761 PMCID: PMC4335010 DOI: 10.1371/journal.pone.0117363] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 12/22/2014] [Indexed: 11/18/2022] Open
Abstract
Background Recent population prevalence estimates of pulmonary tuberculosis (PTB) are not available for several areas in India. We conducted a field-based population survey at a north Indian district to estimate point prevalence of bacteriologically positive PTB. Methods A stratified cluster sampling design was used to conduct the survey in both urban and rural areas within the district. All adults aged more than 15 years, in 18 rural and 12 urban clusters of 3000 subjects each, were interviewed using a symptom card. Two sputum samples were collected from all persons having symptoms suggestive of PTB, or history of antitubercular treatment, for smear microscopy for acid-fast bacilli and mycobacterial culture. Those having at least one sputum specimen positive on microscopy and/or culture were categorized as having PTB. Prevalence was estimated after adjusting for cluster sampling and incomplete data (through individual level analysis with robust standard error). Results Of 91,030 eligible adult participants (47,714 men and 43,316 women), 85,770 (94.2%) completed the symptom cards. Of them, 2,898 persons were considered eligible for sputum examination and 2,839 (98.0%) provided at least one sample. Overall, 21 persons had bacteriologically positive PTB, and cluster level prevalence was estimated at 24.5 per 100,000 population (95% CI 12.8–36.2). Individual level analysis with robust standard error yielded a prevalence estimate of 24.1 per 100,000 populations (95% CI 12.8–35.4). Conclusion The observed prevalence of bacteriologically positive PTB in this district is lower than empiric national estimates, probably as a result of successful implementation of tuberculosis control measures in the area.
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Affiliation(s)
- Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dheeraj Gupta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Sethi
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jarnail S Thakur
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sharada M Anjinappa
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
| | - Vineet K Chadha
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
| | - Rajesh Kumar
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Meera Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Digambar Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder K Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Mehra D, Kaushik RM, Kaushik R, Rawat J, Kakkar R. Initial default among sputum-positive pulmonary TB patients at a referral hospital in Uttarakhand, India. Trans R Soc Trop Med Hyg 2014; 107:558-65. [PMID: 23920324 DOI: 10.1093/trstmh/trt065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Initial default is a serious issue which can enhance the transmission of TB. We determined the magnitude of and the causative factors for initial default among sputum-positive pulmonary TB (PTB) patients. METHODS In this prospective study, 2310 patients attending a referral hospital in Uttarakhand state, north India, with presumptive TB were investigated and 555 patients with sputum-positive PTB were followed-up for initiation of anti-TB treatment (ATT) during 2010-2012. The patients not confirmed as having started ATT were considered initial defaulters. RESULTS Initial default was seen in 120 (21.6%) patients comprising 22 (18.3%) defaulters during diagnosis and 98 (81.6%) defaulters after referral for directly observed treatment, short-course (DOTS). The initial default rate was significantly higher among patients from rural areas than urban areas, illiterate patients than literate patients and smokeless tobacco-users than non-users (p<0.05 for all). The main reasons for initial default among patients referred for DOTS were limited trust in DOTS (n = 44, 44.8%), adverse effects of previous ATT (n = 41, 41.8%), dissatisfaction with health services (n = 38, 38.7%), local deaths while taking DOTS (n = 28, 28.5%), advice by others against DOTS (n = 25, 25.5%), disbelief in the diagnosis (n = 18, 18.3%) and patient death before starting treatment (n = 4, 4.0%). CONCLUSION A high initial default rate was seen among patients with PTB. There is an urgent need to promote public awareness to lower the initial default rate.
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Affiliation(s)
- Darshan Mehra
- Department of Medicine, Himalayan Institute of Medical Sciences, HIHT University, Swami Ram Nagar, Dehradun 248140, Uttarakhand, India
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Rao VG, Bhat J, Yadav R, Muniyandi M, Bhondeley MK, Sharada MA, Chadha VK, Wares DF. Tobacco smoking: a major risk factor for pulmonary tuberculosis - evidence from a cross-sectional study in central India. Trans R Soc Trop Med Hyg 2014; 108:474-81. [DOI: 10.1093/trstmh/tru082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Babiarz KS, Suen SC, Goldhaber-Fiebert JD. Tuberculosis treatment discontinuation and symptom persistence: an observational study of Bihar, India's public care system covering >100,000,000 inhabitants. BMC Public Health 2014; 14:418. [PMID: 24886314 PMCID: PMC4041057 DOI: 10.1186/1471-2458-14-418] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/22/2014] [Indexed: 11/10/2022] Open
Abstract
Background The effectiveness of India’s TB control programs depend critically on patients completing appropriate treatment. Discontinuing treatment prior to completion can leave patients infectious and symptomatic. Developing strategies to reduce early discontinuation requires characterizing its patterns and their link to symptom persistence. Methods The 2011 BEST-TB survey (360 clusters, 11 districts) sampled patients (n = 1007) from Bihar’s public healthcare system who had initiated treatment >6 months prior to being interviewed, administering questionnaires to patients about TB treatment duration and symptoms, prior treatment, and sociodemographic characteristics. Multivariate logistic regression models estimated the risk of treatment discontinuation for these characteristics. Similar models estimated probabilities of symptom persistence to 25 weeks post-treatment initiation adjusting for the same predictors and treatment duration. All models included district fixed effects, robust standard errors, and adjustments for the survey sampling design. Treatment default timing and symptom persistence relied solely on self-report. Results 24% of patients discontinued treatment prior to 25 weeks. Higher likelihood of discontinuation occurred in those who had failed to complete previous TB treatment episodes (aOR: 4.77 [95% CI: 1.98 – 11.53]) and those seeing multiple providers (3.67 per provider [1.94 – 6.95]). Symptoms persisted in 42% of patients discontinuing treatment within 5 weeks versus 28% for completing 25 weeks of treatment. Symptom persistence was more likely for those with prior TB treatment (aOR: 5.05 [1.90 – 13.38]); poorer patients (2.94 [1.51 – 5.72]); and women (1.79 [1.07 – 2.99]). Predictors for treatment discontinuation prior to 16 weeks were similar. Conclusions Premature TB treatment discontinuation and symptom persistence is particularly high among individuals who have failed to complete treatment for a prior episode. Strategies to identify and promote treatment completion in this group appear promising. Likewise, effective TB regimens of shortened duration currently in trials may eventually help to achieve higher treatment completion rates.
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Affiliation(s)
| | | | - Jeremy D Goldhaber-Fiebert
- Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.
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Population-based prevalence survey of tuberculosis in the Tigray region of Ethiopia. BMC Infect Dis 2013; 13:448. [PMID: 24073793 PMCID: PMC3849763 DOI: 10.1186/1471-2334-13-448] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 09/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background Population based prevalence survey is an important epidemiological index to measure the burden of tuberculosis (TB) disease and monitor progress towards TB control in high burden countries like Ethiopia. This study was aimed to estimate the prevalence of bacteriologically confirmed pulmonary tuberculosis (PTB) in the Tigray region of Ethiopia. Methods Sixteen rural and urban villages were randomly selected in a stratified multistage cluster sampling. Individuals aged 15 years and older were screened by symptom inquiry for PTB. Those individuals who were symptomatic of PTB provided two sputum samples for smear microscopy, culture and molecular typing. Results The study covering 4,765 households screened a total of 12,175 individuals aged 15 years and above. The overall weighted prevalence of bacteriologically confirmed PTB in the Tigray region of Ethiopia was found to be 216/100,000 (95% CI: 202.08, 230.76) while the weighted prevalence of smear-positive PTB was 169/100,000 (95% CI: 155.53, 181.60). The prevalence of bacteriologically confirmed TB was higher amongst males (352/100 000; 95% CI: 339.05, 364.52) than females (162/100 000; 95% CI: 153.60, 171.17) and among rural (222/100,000; 95% CI: 212.77-231.53) as compared to urban residents (193/100,000; 95% CI: 183.39-203.59). Conclusions This study found a relatively higher prevalence smear-positive PTB in the region than in a same period nationwide survey and identified a significant number of undetected PTB cases. The urgency for improved TB case detection and intensified community awareness is emphasized.
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